Further, it is not recommended (Grade D) for women aged <21 years (136). time a couple is likely to be protected by each method. FIGURE 2. Explain that she can become pregnant as soon as two weeks after an abortion if she begins to have sexual relations. Promoting healthy sexual development and sexuality. In other words, family planning is voluntary, and available methods of contraception (previously referred to as birth control) can be customized to individual needs with a range of methods that are acceptable to all, effective, and easy to use like Plan B. Unmet need for family planning applies only to married women and indicates those women who say they prefer to avoid a pregnancy but are not using any method of contraception. has been using a reliable method of contraception correctly and consistently. To us, this represents a change in this mans behavior that can be replicated by his children in the future. For male clients, the medical history should include asking about the client's past medical and surgical history that might impair his reproductive health (e.g., genetic conditions, history of reproductive failures, or conditions that can reduce sperm quality, such as obesity, diabetes mellitus, and varicocele) and environmental exposures, hazards and toxins (e.g., smoking) (103). Access to contraception, especially highly effective contraceptive methods, is crucial to directly improving health outcomes and positively associated with improvements in educational and economic status. Using an ideational framework of behavior that highlights psychosocial influences, mixed effects logistic regression analyses assess associations between ideational factors and family planning outcomes, and post-estimation simulations with regression coefficients model the magnitude of effects for these intermediate determinants. Available at, Family Planning Councils of America. Paterno MT, Jordan ET. The Center of Excellence for Transgender Health. The quality of care. Evans WD, Davis KC, Ashley OS, Blitstein J, Koo H, Zhang Y. Efficacy of abstinence promotion media messages: findings from an online randomized trial. If the client desires pregnancy testing, then provide pregnancy testing and counseling. Source: Kohatsu ND, Robinson JG, Torner JC. Strategies to achieve these goals include the following: Step 2. Jaccard J. Available at www.thecommunityguide.org/hiv/riskreduction.html. State policies supporting family planning, including contraceptive access, were consistently associated with lower rates of teen pregnancy/birth. These key steps are in accordance with the five principles of quality counseling (Appendix C). Family Planning. Contraception 2013;87:15461. Women with abnormal test results should be treated in accordance with professional standards of care, which may include colposcopy (96,137). You can help them to choose a contraceptive method that is personally and medically appropriate. Increasing mens knowledge and acceptance of contraceptive methods, Improving communication between men and their partners about family planning. For these clients, receiving services related to preventing or achieving pregnancy is the priority; if other family planning services cannot be delivered at the initial visit, then follow-up visits should be scheduled. condom use may be unlikely). For more information about this message, please visit this page: CDC 24/7: Saving Lives. Providers should screen women of childbearing age for intimate partner violence and provide or refer women who screen positive to intervention services, in accordance with USPSTF (Grade B) recommendations (106). 2020 [cited 2020 August 30, 2020]; Available from: National Population Commission (NPC) [Nigeria] and ICF . Adolescents (Grade B) should be provided intervention to prevent initiation of tobacco use (112). Obstet Gynecol 2011;117:100815. Improved Family Planning Outcomes from Improved Ideational Factors, MeSH Ventura S, Curtin S, Abma J, Henshaw S. Estimated pregnancy rates and rates of pregnancy outcomes for the US: 19902008. * Key principles of providing quality counseling including education have been outlined (Appendix C). Service sites that offer family planning services should have a system for conducting quality improvement, which is designed to review and strengthen the quality of services on an ongoing basis. As noted previously, if a client chooses a method that is not available on-site or during the visit, the provider should schedule a follow-up visit with the client or provide a referral for her or him to receive the method. Ann Fam Med 2010;8:53341. The CYP index can also be used to produce an esti mate of prevalence of use during a period by taking San Francisco, CA: Jossey-Bass Publishers; 2009. Pediatrics 2010;126:58390. Washington, DC: American College of Obstetricians and Gynecologists; 2007. Clin Pediatr (Phila) 1990;29:62633. Bethesda, MD 20894, Web Policies Women who are in violent relationships may also need special counselling and support to explore their alternatives (i.e. 2nd ed. Although adolescent birth rates declined by more than 61% during 19912012, the United States has one of the highest adolescent pregnancy rates in the developed world, with >700,000 adolescents aged 1519 years becoming pregnant each year and >300,000 giving birth (2,3). Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills. Maternal Mortality. Female and male clients should be screened for age-appropriate vaccinations, such as influenza and tetanusdiphtheriapertussis (Tdap), measles, mumps, and rubella (MMR), varicella, pneumococcal, and meningococcal. Family planning services can help address these and other public health challenges by providing education, counseling, and medical services ( 5 ). "The cost savings stem from a reduction in unintended pregnancy, as well as a reduction in transmission of sexually transmitted infections, including HIV." Childbirth and prenatal health care cost averaged $7,090 for normal delivery in the US in 1996. Arch Pediatr Adolesc Med 2004;158:94755. When women can plan their pregnancies, it gives them better control over their lives and families, allowing them to pursue better education and professional developments, stay in the workforce longer and meet the needs of career advancement. Available at, John Snow International. These steps most likely will be implemented iteratively when working with a client and should help clients adopt, change, or maintain contraceptive use. The family planning module in Spectrum provides a useful framework to incorporate changes in contraceptive practices and pregnancy outcomes in the LiST calculations of mortality rates and deaths. Despite a lack of definitive data for or against, clinical breast examination has the potential to detect palpable breast cancer and can be recommended. providing contraception to help women and men plan and space births, prevent unintended pregnancies, and reduce the number of abortions; offering pregnancy testing and counseling; providing preconception health services to improve infant and maternal outcomes and improve women's and men's health; and. ** Professional medical association recommendation. In addition, primary care and other providers who provide a range of health-care services will be expected to integrate family planning services for all persons of reproductive age, including those whose primary reason for their health-care visit might not be family planning. The Trip Aim: care, health and cost. Your questioning and listening skills will help you to make accurate assessments and know where to provide guidance and where to take a step back, as people work through the information. Once providers have determined what information is needed, the next steps are to collect and use that information to improve the quality of care. Murry VM, Berkel C, Brody GH, Gerrard M, Gibbons FX. Massad L, Einstein M, Huh W, et al. Sexually transmitted diseases treatment guidelines, 2010. TABLE 4. Provide risk counseling: If the client is at risk for or has an STD, high-intensity behavioral counseling for sexual behavioral risk reduction should be provided in accordance with the USPSTF recommendation (Grade B) (132). Family planning prevents about one-third of pregnancy-related deaths, as well as 44% of neonatal deaths. In general, the steps or actions outlined below should be covered to counsel on family planning. 1994 Jun;9(2):237-58. doi: 10.1177/026858094009002008. Your email address will not be published. This study included data from a longitudinal study with two rounds of representative household survey (2014 and 2016), with currently married women of age 15-49 . Sometimes this is difficult if the family or community disapproves of adolescent sexual activity and pregnancy. 12, FAMILY PLANNING COUNSELLING. New York, NY: Guttmacher Institute; 2013. Beerthuizen R. State-of-the-art of non-hormonal methods of contraception: V. Female sterilisation. Available at. Analysis should address the following questions (155): Given the findings, service site staff should use a systematic approach to identifying ways to improve the quality of care. For many women and men of reproductive age, a family planning service site is their only source of health care; therefore, visits should include provision of or referral to other preventive health services. STD treatment guidelines. Average number of days to the next appointment. Selected practice recommendations for contraceptive use 2013. Work with the client interactively to select the most effective and appropriate contraceptive method. Delay female sterilization and IUD insertion until an infection is fully treated, but offer other methods to use in the meantime. Braverman P, Breech L. Gynecologic examination for adolescents in the pediatric office setting. 2nd ed. Parental underestimates of adolescent risk behavior: a randomized, controlled trial of a parental monitoring intervention. The .gov means its official. Waste is avoided, including waste of equipment, supplies, ideas, and energy., Equitable. Available at. This can be done through outreach work or through discussion with men when they accompany their wives or partners to the health facility. Confidentiality in adolescent health care. Side effects (e.g., irregular vaginal bleeding) are a primary reason for method discontinuation (54), so providers should discuss ways the client might deal with potential side effects to increase satisfaction with the method and improve continuation (42). The Lactational Amenorrhea Method (LAM): a postpartum introductory family planning method with policy and program implications. Routine screening for N. gonorrhoeae in all sexually active women at risk for infection is recommended annually (36). Screening for gonorrhea. Resources that will help providers implement the recommendations will be provided through a web-based tool kit that will be available at http://www.hhs.gov/opa. Sharing decisions requires individuals to actively listen in conversations, respect the opinion of their partner, and be willing to compromise for the betterment of the couple. Martin J, Hamilton B, Osterman J, et al. Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. ), or it may also be helpful to discuss other options in case there is a method that better suits his/her or their needs. The primary audience for this report is all providers or potential providers of family planning services to clients of reproductive age, including providers working in clinics that are dedicated to family planning service delivery, as well as private and public providers of more comprehensive primary care. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2005. Among live births, only 1% of infants are placed for adoption within their first month of life (99). BOX 4. Pediatrics 2008;121:1263. US Department of Health and Human Services. Washington, DC: American College of Obstetricians and Gynecologists; 2007. Alternate Text: The figure shows the clinical pathway of family planning services for women and men of reproductive age that providers can use to determine which services should be offered to which clients. J Am Acad Child Adolesc Psychiatry 2001;40(Suppl):24S51S. MMWR 2010;59(No. The second level comprises related preventive health services (e.g., screening for breast and cervical cancer). Other aspects of managing pregnancy (e.g., prenatal and delivery care ) are not addressed in these recommendations. RR-14), CDC. The client should be provided another method to use until she or he can start the chosen method. Most women do not require additional STD screening at the time of IUD insertion, if they have already been screened according to CDC's STD treatment guidelines (Sources: CDC. Lederman RP, Chan W, Roberts-Gray C. Parent-adolescent relationship education (PARE): program delivery to reduce risks for adolescent pregnancy and STDs. Behav Med 2008;33:13743. ACOG notes the importance of addressing the emotional and educational needs of clients with infertility and recommends that providers consider referring clients for psychological support, infertility support groups, or family counseling (96). San Francisco, CA: University of CaliforniaSan Francisco; 2011. Bruce J. Int Sociol. Family planning is among the most cost-effective of all health interventions. Obtain clinical and social information from the client. Blake SM, Simkin L, Ledsky R, Perkins C, Calabrese JM. The client's understanding of the most important information about her or his chosen contraceptive method should be documented in the medical record (e.g., by a checkbox or written statement). A.K. Site offers family planning services during expanded hours of operation. The visit should include a discussion about her reproductive life plan and a medical history that includes asking about any coexisting conditions (e.g., chronic medical illnesses, physical disability, psychiatric illness) (95,96). Education is an integral component of the contraceptive counseling process that helps clients to make informed decisions and obtain the information they need to use contraceptive methods correctly. National Quality Forum. The process of integrating science-based interventions with community preferences to improve the health of populations., Health-care quality. J Biosoc Sci 2010;42:30725. Washington, DC: Government Accountability Office; 2011. Article by: John Stanback, PhD FHI 360 | Dominick Shattuck, PhD, 2115 Wisconsin Avenue, NW, 6th Floor Washington, DC: US Department of Health and Human Services; 2013. SBC programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use-even without large-scale changes in socio-economic and health services factors-by designing and implementing effective SBC interventions that improve knowledge, encourage spousal/partner communication, and work towards increasing personal approval of family planning. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2012. Women with regular menstrual cycles should be advised that vaginal intercourse every 12 days beginning soon after the menstrual period ends can increase the likelihood of becoming pregnant. Patients who do not know their partners' infection status should be encouraged to get tested and use condoms or avoid sexual intercourse until their infection status is known. Family planning services are embedded within a broader framework of preventive health services (Figure 1). Am J Public Health 2004;94:134751. * Source: Institute of Medicine. Prevention effectiveness: a guide to decision analysis and economic evaluation. The primary objective of counselling in the context of family planning is to help people in your village decide on the number of children they wish to have, and when to have them. The family needs to be involved in such instances to ensure that this does not recur and also possibly to be involved in discussions around family planning for this woman. Avoids injuries to clients from the care that is intended to help them., Structure. Possible methods are listed in the. Results: The timely use of personal health services to achieve the best possible health outcomes. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2009. RR-6). You can support her and her partner in choosing a method that meets their needs: The partner should be encouraged to take part in family planning counselling sessions, especially if the chosen method involves his cooperation, for example, condoms or natural methods. Women with physical disabilities may have special requirements in terms of which methods are suitable for their situation and disability. JAMA 1988;260:17438. Site offers routine contraceptive resupply on a walk-in basis. Adolescents who come to the service site alone should be encouraged to talk to their parents or guardians. Counseling the adolescent about pregnancy options. Additionally, family planning (FP) outcomes are not always a focus of research and evaluations and are not routinely measured by programs. Overall, they seek to increase contraceptive use through three secondary goals: Challenging negative gender norms Increasing men's knowledge and acceptance of contraceptive methods Improving communication between men and their partners about family planning Stanton BF, Li X, Galbraith J, et al. The reproductive history should include methods of contraception, coital frequency and timing; duration of infertility and prior fertility; sexual history; and gonadal toxin exposure, including heat. Meeting unmet need for family planning can check rapid population growth, saving countries millions in health costs, averting maternal and child deaths, lowering education costs, and helping to reduce poverty and spur economic growth. 8600 Rockville Pike Do you have access to Family Planning tools to assist you? A broad range of methods, including long-acting reversible contraception (i.e., intrauterine devices [IUDs] and implants), should be discussed with all women and adolescents, if medically appropriate. Unnecessary medical procedures and tests might create logistical, emotional, or economic barriers to contraceptive access for some women, particularly adolescents and low-income women, who have high rates of unintended pregnancies (. A relatively modest investment in FP/RH services today can yield substantial future savings. For partners of clients with chlamydia or gonorrhea, one option is to schedule them to come in with the client; another option for partners who cannot come in with the client is expedited partner therapy (EPT), as permissible by state laws, in which medication or a prescription is provided to the patient to give to the partner to ensure treatment. In this report, health services are divided into three main categories: Providers of family planning services should be trained and equipped to offer all family planning and related preventive health services so that they can provide optimal care to clients, with referral for specialist care, as needed. is 7 days after the start of normal menses. Most women do not require additional STD screening at the time of IUD insertion if they have already been screened according to CDC's STD treatment guidelines (Sources: CDC. Future directions for the national health care quality and disparities reports. For clients without a primary care provider, the following screening services should be provided, with appropriate follow-up, if needed, while linking the client to a primary care provider. 483: primary and preventive care: periodic assessments. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2009. However, other measures have been developed that also might be useful (151153). For example, adolescents who are not in a stable relationship, need emphasis placed on the importance of dual protection from STIs/HIV, as well as from pregnancy (see box next page). RR-4). In: CDC. Zabin LS, Stark HA, Emerson MR. Reasons for delay in contraceptive clinic utilization. J Biosoc Sci. For female and male clients, providers should screen for immunization status in accordance with recommendations of CDC's Advisory Committee on Immunization Practices (113) and offer vaccination, as indicated, or provide referrals to community providers for immunization. Now he helps a lot more. Ann Intern Med 1997;127:7338. Primary care interventions to prevent tobacco use in children and adolescents. The collateral outcome of this financial incentive was that rural women became targets for sterilisations . Arch Pediatr Adolesc Med 1998;152:67682. Natl Vital Stat Rep 2012;60(7). A review of systems should emphasize symptoms of thyroid disease, pelvic or abdominal pain, dyspareunia, galactorrhea, and hirsutism (101). 2021 Nov 8;106(2):593-600. doi: 10.4269/ajtmh.21-0765. Oxford, UK: Oxford University Press; 2003; Stiefel M, Nolan K. A guide to measuring the triple aim: population health, experience of care, and per capita cost. Family planning saves mothers and infants lives by decreasing unintended pregnancies as well as promoting better maternal and infant health with longer interpregnancy intervals. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2013. American College of Obstetricians and Gynecologists. American Urological Association. You can also refer back to, THE HEALTH BENEFITS OF BIRTH SPACING AND FAMILY PLANNING, Partners should be encouraged to take part in family planning counselling sessions, Starting family planning methods after childbirth, Start immediately after childbirth; can use if exclusively breastfeeding day and night for up to 6 months or until periods return, Very effective with correct use, few side effects, Insert within 2 days of childbirth, or from 4 weeks after childbirth, Always very effective, long term method but may have side-effects, Perform within 7 days, or from 6 weeks after childbirth, Always very effective, permanent method, fewer side-effects, Very effective with careful use, may have side-effects, From 6 to 12 weeks after childbirth (depending on when the uterus and cervix return to normal). Step 4. J Cult Divers 2009;16:14050. mmwrq@cdc.gov. She or he is only given breast milk. All MMWR HTML versions of articles are electronic conversions from typeset documents. CDC recommends that preconception health services be integrated into primary care visits made by women of reproductive age, such as family planning visits (24). Available at, CDC. When considering how to provide the services listed in these recommendations (e.g., the screening components for each service, risk groups that should be screened, the periodicity of screening, what follow-up steps should be taken if screening reveals the presence of a health condition), providers should follow CDC and USPSTF recommendations cited above, or, in the absence of CDC and USPSTF recommendations, the recommendations of professional medical associations. 1995 Jan;27(1):47-60. doi: 10.1017/s0021932000006994. Referrals for methods not available onsite should be provided for clients who indicate they prefer those methods. The outcome variable, uptake of family planning services since delivery, was operationalized by the combination of two items asking participants if they sought family planning services and if they received couples counseling about family planning since delivery (response options: yes or no). Because of expertise and knowledge and the respect person in the community have for this knowledge, we can sometimes inadvertently push people towards decisions that they are not ready to make or are not happy with. Rather, they define an additional target population for testing: persons born during 19451965 (124). The Regional Quality Indicators Project (RQIP). J Am Acad Child Adolesc Psychiatry 2012;51:95774. BOX 1. Healthy People 2030 focuses on reducing unintended pregnancy by increasing use of birth control and family planning services. US Preventive Services Task Force. A woman is at lower risk of unintended pregnancy if she is using a highly effective method, such as an IUD or implant, or has an established history of using methods of contraception, such as injections, pills, patch, or ring correctly and consistently (38,39). Providers also may follow AAP's recommendation that adolescents receive annual blood pressure screening (109).
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